The Spirituality of Compassion: A Public Health Response to Ageing and End-of-Life Care

SUMMARY

The recent revival of interest in spirituality in later life marks a significant step forward in the person-centred care of ageing people. The benefits will, however, be of limited value if we do not attend to the settings in which spirituality is to be lived. In contemporary society many aged people are located in environments unsympathetic to spiritual belief and practice. Health care settings focus on professionally-assessed physical needs and are dominated by concerns about the cost of services. The national social policies that direct health care services and less directly shape older people's place in contemporary society are strongly influenced by globalised neoliberal economic policies characterised by individualism, competition, and greed. For robust and viable spirituality to develop at the individual level we need compassionate social policies that support interdependence within communities and between nations.     

The Care of the Ultra-Orthodox Jewish Patient

The Ultra-Orthodox Jewish community embraces a system of values and a rigorous behavioral code that are deeply rooted in religious tradition and history. Here we describe some of the unique challenges that stem from the encounter between modern medical practice and the Ultra-Orthodox world. Through examples of clinical and ethical scenarios ranging from prenatal care to end-of-life decisions, we illustrate problems related to observance of age-old practices in a modern hospital setting, balancing acceptance of Divine will with standard risk assessment, reconciliation of patient autonomy with deference to rabbinic authority and fear of stigma associated with mental illness in a traditional society. We also offer a generalizable model where inquiry precedes pre-formulated judgment to help clinicians provide enhanced care for this population.     

从社会医学角度整体地关照病人的需要

医学模式代表了三个主要历史时代发生的特征性变化,这三个时代是前工业化时代,工业时代及我们目前正在步入的后工业化时代,需要讨论的是,如果要展开真正有效的社会医学实践,不仅医学知识,并且医务人员必须经历一个根本的转变,从历史上看,医生学到的是将医学界定为应用生物学及将疾病界定为机体器官,组织的结构和功能的不正常。但社会科学观点可以帮助医生认识病和症的区别,即它们仅仅是在病理心理学过程与病人的实际疾病的体验之间上有所区别。     

Religion and Happiness Among Israeli Jews: Findings from the ISSP Religion III Survey

This study investigates religious predictors of happiness in a population-based sample of Israeli Jewish adults (N = 991). Using data collected in 2009–2010 as a part of the International Social Survey Programme’s Religion III Survey, analyses were conducted on a fully recursive structural model of the effects of synagogue attendance and several religious mediators on a single-item measure of happiness. Bivariately, every religious measure (synagogue attendance, prayer frequency, certainty of God beliefs, a four-item Supernatural Beliefs Scale, and subjective religiosity) is positively and significantly associated with happiness. In the structural model, 11 of 15 hypothesized paths are significant. Of these, only subjective religiosity exhibits a significant direct effect on happiness (β = 0.15, p < .01). The other four religious indicators, however, all exert indirect effects on happiness through subjective religiosity and combinations of each other. Total effects on happiness of both synagogue attendance (β = 0.10, p < .01) and the Supernatural Beliefs Scale (β = 0.12, p < .05) are statistically significant. Analyses adjust for effects of age and other sociodemographic covariates. Results build on a growing body of population-based findings supporting a salutary impact of Jewish religious observance on subjective well-being in Israel and the diaspora.     

Death in Hospital: The Place of Religion in the Care of the Patient

The reflections in this article are based on my experience over the past ten years as hospital chaplain of a large district general hospital within the UK National Health Service. I realize the limitations of this experience, but I hope that I may achieve some insights that have a wider application. I attempt to bring my hospital experience into a creative relationship with other aspects of my life, which include a commitment to Christian–Muslim dialogue, and a background of life and work in the Middle East, where I worked for the Anglican Church in Lebanon and Syria from 1973 until 1982.     

晚期癌症与安乐死的探讨

对136例无救治希望的晚期癌症患者及家属进行问答式调查,旨在分析安乐死在晚期癌症患者中实施的可行性.结果,只有2.2%的患者欲选择安乐死,家属均不选择安乐死;95.6%的患者和97.8%的家属选择临终关怀或姑息治疗.因此,安乐死难以为人们所接受.     

To Be With Them: A Hospital Chaplain's Reflection of the Bedside Ministry to Terminally III and Dying People

The author, an ordained Lutheran pastor, reflects upon his experiencesas chaplain at a small hospital in southwestern Germany (Tropenklinik– Paul Lecher Krankenhaus, Tübingen). Besides itsexpertise in the treatment of tropical diseases this 100 + bedhospital serves as the referral hospital for terminally illand dying patients from the local University hospitals and thesurrounding area. The experiences at the bedside of such patientswith various denominational and religious backgrounds challengedthe chaplain to go beyond the confines of any fixed theologicalsystem or counseling technique. They made him to discover threeessentials as the very basis of such ministry, which he sharesin this article. He identifies these as (1) the necessity torealize the situation sober mindedly, (2) the desire to becomea companion, and (3) the venture of confident faith, where holdingon to any genuine perspective of life is deemed ridiculous.     

晚期癌症与安乐死的探讨

对136例无救治希望的晚期癌症患者及家属进行问答式调查,旨在分析安乐死在晚期癌症患者中实施的可行性。结果,只有2.2%的患者欲选择安乐死,家属均不选择安乐死;95.6%的患者和97.8%的家属选择临终关怀或姑息治疗。因此,安乐死难以为人们所接受。     

Nurturing Socioculturally and Medically Appropriate Palliative Care Delivery: Lessons Learned by Israeli Medical Faculty

Journal of Religion and Health - Israel is one of the few countries worldwide with a national policy and defined standards of palliative care (PC); its culture is highly diverse and more...     

Multiculturalism and Settlement: The Case of Dutch Postcolonial Migrant Organisations

This article examines the effects of multiculturalism of the 1980s and 1990s on the organisational patterns of immigrant populations in the Netherlands. This is a controversial topic in this country since politics of multiculturalism have allegedly excessively sponsored migrant organisations causing their ??fragmentation?? and having adverse consequences for these organisations?? role in the integration process. Based upon a systematic survey of the available data about postcolonial migrant organisations from 1945 to 2008, our conclusion is that the growth in postcolonial migrant organisations from the 1980s onwards has been impressive. For this specific category of immigrants, there is, however, little in the way of evidence that links this growth, or fragmentation of the landscape of migrant organisations for that matter, to Dutch multicultural minorities policies. Much of the growth should be related to the global phenomena of emerging identity discourses and increasing levels of identity politics. The policy implication is that, at least for the Netherlands, government policies creating favourable conditions for migrant organisations have been discarded without proper justification as counterproductive.     

Fear and Shame in an Israeli Psychoanalyst and His Patient: Lessons Learned in Times of War

Living in the midst of a war presents unique challenges to ongoing psychotherapeutic treatment. This paper focuses on the ever-present threat of fracture to the analytic frame and the limited ability of the therapist to create a safe, insulated environment— a reliable container—in which to work, while coping with a violent external reality. Using an intrapsychic lens, as well as an interpersonal one, the dynamics of both the analyst's and the patient's fear and shame are brought into focus. This delicate balance is illustrated through two cases: one occurring during the First Gulf War (1991) and the second taking place during the Second Lebanon War (2006). In both cases, fear and shame cause a stalemate in the psychotherapeutic process. The analyst recalls his active duty as a soldier during the Yom Kippur War (1973). These memories and their attendant acknowledgement of fear and shame by the analyst, as well as his analysand's “supervisory” comments, gradually dissolve the knot and repair the rupture in the analytic process. The ability to fully experience fear, shame, and helplessness is at the core of psychic health, a health once destroyed by dissociation and denial of these feelings. This ability to experience fear and shame is the psyche's antidote to mental breakdown. Following discussion of the two case studies, this paper seeks to illustrate how the very structure of a society, in this case Israel, can codify societal defense mechanisms against emotions like fear and shame, exacerbating the very problems it seeks to assuage.